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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThis article highlights the first results of the PROMISE trial, which evaluated infarcted myocardial segments in patients following ST-segment elevated myocardial infarction. After 6 months, a significant proportion of segments with transmural necrosis, as detected by early cardiac magnetic resonance imaging, demonstrated improvements in the degree of infarction and function.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emagnetic resonance imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etransmural necrosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eangioplasty\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPROMISE\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT00781404\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EJos\u00e9 Fernando Rodr\u00edguez Palomares, MD, University Hospital Vall d\u2019Hebron, Barcelona, Spain, shared preliminary results from the PROMISE trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00781404\u0026amp;atom=%2Fspmdc%2F14%2F54%2F11.1.atom\u0022\u003ENCT00781404\u003C\/a\u003E] in patients with STEMI in which transmural infarction was identified by cardiac magnetic resonance imaging (CMR) early after STEMI. At the 6-month follow-up, the results demonstrated a decreased extent of infarction in many affected myocardial segments, with significant improvements in their contractile function.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAccording to Prof Rodr\u00edguez Palomares, in patients with acute myocardial infarction, the extent of transmural necrosis, as determined by CMR in the early post-STEMI phase, has been established as an excellent predictor of improvement in myocardial contractile function. However, data from some studies have suggested that the extent of transmural necrosis can be overestimated during the acute phase because of the presence of edema in the infarcted tissue. Prof Rodr\u00edguez Palomares noted that after percutaneous coronary intervention, the recovery of dysfunctional myocardial segments that have an intermediate extent of transmural necrosis is variable, is difficult to predict, and may be related to the contractility of the remaining viable but stunned myocardium. He indicated that additional studies have also addressed this issue in chronic ischemic heart disease, showing that low-dose dobutamine test CMR is superior to extent of infarction for the prediction of functional recovery of myocardial contraction.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EWith this in mind, Prof Rodr\u00edguez Palomares and colleagues conducted the PROMISE trial to investigate the accuracy of the extent of transmural infarction in predicting the presence of contractile reserve and recovery of myocardial function at 6 months post-STEMI.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe study enrolled 95 patients with an acute STEMI. Following successful primary angioplasty, participants underwent CMR and a dobutamine stress echocardiogram during the first week and at 6-month follow-up.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe transmural extent of infarction in myocardial segments was determined by CMR. The researchers evaluated a total of 1520 myocardial segments and categorized transmural infarction as an extent of necrosis \u0026gt;\u200950%. They determined peak longitudinal systolic strain (SS) and systolic strain rate (SSR) at baseline and after infusion of 10 \u00b5g\/kg\/min of dobutamine in 16 myocardial segments in each participant (except the apex, segment 17).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe results showed a decrease in deformation parameters as the extent of transmural necrosis increased: SS and SSR at baseline, after infusion of 10 \u00b5g\/kg\/min of dobutamine, and at 6-month follow up, were decreased with increased extent of transmural infarction. However, at 6 months, the extent of necrosis was significantly decreased, even in transmural infarcts (\u003Cem\u003EP\u2009\u003C\/em\u003E\u0026lt;\u2009.001). Eighty percent of myocardial segments with 50% to 75% infarction, and 48% of those with \u0026gt;\u200975% infarction in the acute phase demonstrated contractile reserve and improvement in myocardial contractile reserve, with concomitant decrease in the extent of transmural necrosis.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProf Rodr\u00edguez Palomares therefore concluded that assessment of the transmural extent of a myocardial infarct early post-STEMI does not accurately predict functional recovery at 6 months and therefore should not be relied upon as an accurate short-term surrogate marker of improvement in myocardial contractile function.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/54\/11.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzob5d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}